Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of DataFunding Sobi Inc. funded this study. Employees of the funding institution contributed to the design of the study; and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication
Objective In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change.
Study Design A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November–March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change.
Results There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67–2.27, p <0.001; 1.70, 95% CI: 1.55–1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations.
Conclusion We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change.
Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update.
Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update.
Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update.
Ethics Approval and Informed Consent
All database records are statistically de-identified and certified to be fully compliant with U.S. patient confidentiality requirements outlined in the Health Insurance Portability and Accountability Act of 1996. Because this study used only de-identified patient records and did not involve collecting, using, or transmittal of individually identifiable data, this study was exempted from Institutional Review Board approval.
* Amanda Kong was employed by IBM Watson Health at the time this study was executed. She is currently employed at Aetion, New York, NY, USA.
† Adam Bloomfield was employed at Sobi at the time this study was executed. He is currently employed at Moderna, Cambridge, MA, USA.
Eingereicht: 21. Mai 2021
Angenommen: 26. September 2021
26. Oktober 2021 (online)
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